IntroductionThe Chughtai Laboratory collects blood samples for complete blood counts from various hospitals, emergency departments, ICUs, and through home sampling services all across the country. The preanalytical phase is an integral component of laboratory medicine. A laboratory report has a key role in patient treatment and the clinician's decision in the management of the disease. Preanalytical errors are most frequently caused by the absence of a sample and/or inappropriate understanding of a test request, mislabeling, contamination from the sampling site, hemolyzed, clotted, insufficient samples, storage issues, and inappropriate blood to anticoagulant proportion or inappropriate choice of anticoagulant. ObjectiveTo identify the cause of rejection rates of the complete blood count samples and reduce the rejection rates by improving the accuracy of the results and lowering pre-analytical errors. MethodsThis cross-sectional study was done in the Hematology Department of Chughtai Laboratory's head office in Lahore between 19-06-2021 and 19-10-2021. Simple random sampling was applied to collect the data. About 3 ml of each blood sample was received in an ethylenediaminetetraacetic acid (EDTA) vial, inspected visually, run on Sysmex XN-9000 (Sysmex Corporation, Kobe, Hyogo, Japan), and was reviewed on peripheral smears. ResultsOut of 231,008 blood samples, 11,897 (5.15%) samples were rejected. The most common pre-analytical mistake was storage issues due to transportation delay (19.45%) followed by wrong medical records (19.16%), diluted samples (16.35%), incorrect tubes (16.01%), hemolyzed samples (15.13%), unlabeled samples (10.01%), and clotted sample (3.88%). ConclusionIn the hematology department, the total rejection rate observed during the study period was 5.15%. Recognition of preanalytical errors and avoiding them will help us lower the sample rejection rate and raise the overall quality of laboratory management.

Objective: To determine the frequency and types of cytogenetic abnormalities in pediatric Acute Myeloid Leukemia. Material and Methods: This cross-sectional study was conducted from January 2021 to October 2021 in Hematology department of the CHUGHTAI Institute of Pathology in Lahore Pakistan. Total 60 patients who were newly diagnosed with Acute myeloid leukemia in CHUGHTAI Institute of Pathology and were also referred from Children Hospital Lahore were included. Patients under the age of 16 years and from both gender were included. Informed consent was taken from patient’s guardian/parents. Patients had their bone marrow aspirates processed for standard G-banding and their karyotypes were examined using a cyto-vision system, where the number of chromosomes was counted and examined for any changes, such as damaged, missing, rearranged, or additional copies of chromosomes. Morphology, immunophenotyping of aspirate, and trephine biopsy are used to make the diagnosis of AML. Data was entered in SPSS version 23.0. Result: There were total 60 patients included in the study. The mean age was 10.2+ 3.2 years. There were n=32(53.3%) males and n=28(46.6%) female. Normal karyotype was observed in n=36(60%) patients, abnormal were seen in n=14(23.3%) and unsuccessful was shown in n=10(16.6%) patients. Favorable cytogenetic results were seen in n=6 (10%), intermediate in n=41 (68.3%), and unfavorable in n=4 (6.6%) cases. t(8;21) (q22:q22) and t(15;17)(q24;q21) were found in 8.3% and 1.6% of our study population respectively which have favorable prognosis . One of our patients had complex cytogenetic abnormalities, including [del5p, del7q, del11q-17+] which shows poor prognosis. Conclusion: The study discovered that 14 (23.3%) of the total pediatric patients with acute myeloid leukemia showed aberrant cytogenetic abnormalities. Chromosomal abnormalities should be identified as early as possible since they can be used for AML risk stratification and prediction of prognosis. Keywords: Acute myeloid leukemia, Complex cytogenetic, Cyto-vision, Karyotype, Morphology, Pediatric

BackgroundNucleated red blood cells (NRBCs) are not normally found in the peripheral blood of normal healthy individuals. The presence of NRBCs on an adult peripheral blood smear indicates that there is an extremely high demand for the bone marrow to manufacture RBCs and that immature red blood cells are being released into the bloodstream. Anemia, myelofibrosis, thalassemia, miliary tuberculosis, malignancies of the bone marrow (myelomas, leukemias, lymphomas), and prolonged hypoxemia are a few possible pathogenic reasons. Critically ill patients who have NRBCs have a high mortality rate and a worse prognosis.Objective: To evaluate the clinical significance of NRBCs in the peripheral blood of critically ill patients admitted to the ICU to find a cut-off to predict mortality. Materials and Methods: A cross-sectional study was carried out over a period of six months September 1, 2020, to March 31, 2021, in Lahore, Pakistan. A total of 800 critically ill patients of both sexes in the age group of 18-70 years were included. Patients younger than 18 years and patients who underwent surgery were excluded. A quantity of 3 ml of whole blood sample in an ethylenediamine tetraacetic acid (EDTA) vial from each patient was run on SYSMEX XN-9000 (Sysmex Corporation, Kobe, Hyogo, Japan) and the results were reviewed on peripheral smears.Results: The incidence of NRBCs in ICU-admitted patients was 62.5% (500/800). The total number of NRBCpositive patients recovering after the treatment was 364 (72.8%). The overall mortality of NRBC-positive patients was 30% (150/500). It was significantly higher (p<0.001) than that of NRBC-negative patients (14%; 44/300). During treatment, the highest mortality rate was seen in patients due to malignancy (100%), followed by sepsis (58.8%). It was observed that the disease pattern and number of NRBCs were significantly different (p<0.001) among all disease groups. However, there was no statistically significant difference in NRBCs on the basis of gender (p >0.05). In our study, a cutoff of NRBCs of 2.50 showed a high risk of mortality with a sensitivity of 91%. Conclusion:The presence of NRBCs may predict mortality in critically ill ICU-admitted patients. Their presence in the blood may be regarded as a marker of severity suggesting a high risk of ICU death.

BackgroundAberrant phenotype expression in acute myeloid leukemia (AML) may be due to genetic defects and is associated with a poor prognosis. CD7 is the first T-cell-associated antigen to be expressed during Tlymphocyte maturation. Aberrant expression of CD7 in AML influences clinical response, remission rate, and overall survival in these patients. ObjectiveTo determine the frequency of aberrant CD7 expression in patients with AML. Materials and methodsThis cross-sectional study was performed over a period of 12 months from July 2020 to June 2021 in the Hematology Department, Chughtai Lab, Lahore. This study included 120 patients who were newly diagnosed with AML. The following tests were performed for included patients: complete blood count (CBC), peripheral blood smear analysis, and flow cytometric analysis using a blood sample or bone marrow aspirate. Blast cells were analyzed for aberrant CD7 expression. Calculation of the sample size was performed by using the Select Statistics calculator. All statistical analyses were performed using SPSS ver. 23 software (IBM Corp., Armonk, NY). Data were expressed as frequencies, means ± standard deviation (SD), and percentages. ResultsOf 120 patients newly diagnosed with AML, the CD7 antigen was aberrantly expressed in 36 cases (30%). Of these patients, the AML2 subtype was the most common type of AML with aberrant CD7 expression, followed by AML M4, AML M1, M3, AML M5, and AML M0, respectively. ConclusionIn our study, aberrant CD7 expression occurred at a high frequency in acute myeloid leukemia. Thus, this marker should be added to the current flow cytometry panels.

BackgroundA high red cell distribution width (RDW), which indicates ongoing inflammation, and low levels of highdensity lipoprotein-cholesterol (HDL-C) are associated with increased mortality and morbidity in patients with coronary artery disease (CAD). Recent studies have suggested that HDL-C possesses anti-inflammatory and antioxidant effects, which may explain its anti-atherogenic properties. This study aims to determine the relationship between HDL-C levels and RDW in patients with CAD. Materials and methodsThis cross-sectional study was performed on 120 patients with CAD from July 2020 to June 2021 in the Hematology Department of Chughtai Lab Lahore. Patients were graded according to the degree of coronary artery stenosis as follows: Grade 1,30%-50%; Grade 2, 51%-70%; and Grade 3,>70%. The HDL-C level was measured from venous blood samples by a fully automated Abbot Alinity analyzer. The RDW was measured by Sysmex XN-5000. The sample size was calculated using the Select Statistics calculator. The mean RDW and HDL-C of the patients were calculated, and correlation analyses were performed using the Pearson correlation coefficient. ResultsThe HDL-C level was inversely related to the RDW. Of the 120 patients, 38, 44, and 38 had Grade 1, Grade 2, and Grade 3 stenosis, respectively. The mean HDL-C level and RDW were 30.58 ±3.77 mg/dL and 16.04% ±1.66%, respectively. The value of r was −0.8622 (strongly negative). Data were stratified based on the degree of stenosis. The values of r in Grades 1, 2, and 3 were −0.43 (moderately negative), −0.604 (moderately negative), and −0.27 (weakly negative), respectively. ConclusionThe RDW can be used as an additional marker to determine the disease status in CAD patients.